Now, they are entering the final stage of restructuring where they are working toward providing excellent care, CEO Timothy Jones said.

"This place has survived and we will perform better in the future," Jones said during a meeting with reporters on Tuesday.

The organization has taken several steps in recent years to reinvigorate what was an economically failing hospital. Northern Berkshire Healthcare began with the selling of Sweetwood and Sweet Brook in Williamstown, went through a series of layoffs and then filed Chapter 11 bankruptcy to rid themselves of overwhelming debt. The debt was cut by about a third in that process.

The organization incurred a one-time $4.1 million cost for restructuring during the bankruptcy process but have now landed on their feet. Moving forward, Jones says the hospital will be focused on a "lean strategy" in finding and reducing all unneeded costs while improving patient care.

One major step in providing that care will come from partnering with Berkshire Health System in Pittsfield.

"In order for this to financially work, you need to have a very big patient base, not just 35,000 in the North Adams area, not even 75,000 in Berkshire County. You have to have 100,000 to make this work," Board of Trustees Chairman Arthur Turton said of changes in health care payments that focus on care of a patient instead of per visits. "All small hospitals like this are certainly going to have to become part of large organizations."

He also said the affiliation will allow more access to services outside of the hospital. Recently, Northern Berkshire Healthcare partnered with Berkshire Health Systems in the Williamstown Medical Associates but that is just the beginning of a bigger partnership.

Jones recently took over as president and has his sights on turning the hospital into the safest one in Massachusetts.

Meanwhile, while all of the worry has been on the financial side, the hospital is now switching gears to focus on improving the care they deliver. Jones said this year will focus on "safety, flow, engagement and cost."

In the quest to become the safest hospital in the state, Jones said they are reexamining all of their processes to prevent accidents that could harm either patients and employees.

"The number 1 priority of any patient that enters this hospital is 'please don't hurt me.' That's the number one thing. That comes even before fixing them," Jones said.

Also in operational changes, the hospital is focusing on moving patients in and out of the hospital appropriately. For example, there are patients who go to the emergency room and leave before being seen because of the wait. Jones said they have already changed operations to make sure the patients see a nurse as soon as possible to keep those patients from leaving.

With the major costs issues behind them, the hospital is also looking at reducing other expenses they incur.

Jones gave the amount of paper is an example. If all the paper the hospital uses in a year was stacked, it would span twice the height of Mount Greylock. This year they will be focused on finding ways to cut out that usage to save money.

"We will be focusing on our lean strategy. We will be looking at our processes and focusing on the elimination of waste," Jones said.

More than a $500,000 is spent on electricity every year and that will be another area Jones looks to increase savings.

These next steps are what hospital officials consider the "final stage" of restructuring. With fewer assets, they are now focused on getting the best out of what they currently have to create sustainability

"Our primary initiative isn't going to be substantial growth. It's going to be operational excellence," said Chief Financial Officer Christopher Hickey in response to a question about the possible growth of services.

"This is the type of focus we couldn't even talk about a year ago because we were so focused on how do we pay the bills and on the restructuring. That's what is so exciting. We have to think about issues like this," Turton said. "I am excited about the future of this organization."

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